Prep for R1 year

[ashar008]

Hello fellow rad residents. I am currently in my intern year in a categorical program. As the year draws near to its half way point I am getting more and more anxious about R1 year. Most of my time has been either working long ICU or medicine ward hours and barely having the time or energy to come home and read something related to radiology. And even when I read I have to split it with step 3 questions. I am getting more and more anxious that I am not ready foundation wise for R1 year. I am starting to read some introductory radiology books for general practitioners like Felson's or Learning Radiology but they just don't seem enough. I then try to read Brant and Helms and get overwhelmed with the content. Any advice or tips on how to prepare for R1 year? What have you guys done to have good start going into R1 year. Thank you.

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[Iben_Sina]

I am in a similar situation. Please advise guys.

 

[Aurum]

The expectation on your first day of R1 is that you know zero. I subsequently would not stress about trying to prepare for R1. If you get through Felson's and watch a few YouTube videos on basic search pattern/anatomy for head and abdomen CTs in the month leading up to R1, you will be ahead of the curve.

Focus on personal wellness (exercising, hobbies, whatever floats your boat) whenever you can during this uniquely awful time in your life so that you can hit the ground running and aren't recovering from intern year burnout during R1.

 

[GoPelicans]

Reading would be so useless, it would be like preparing for anatomy by flipping through Netter's the summer before med school. If you look at the imaging of your patients in intern year and try to find what the radiology report is talking about you will be further ahead than 90% of people.

 

[Cognovi]

Reading would be so useless, it would be like preparing for anatomy by flipping through Netter's the summer before med school. If you look at the imaging of your patients in intern year and try to find what the radiology report is talking about you will be further ahead than 90% of people.

Ditto looking at the radiology reports carefully. Soon you will be on the other end of the powermic and will struggle to remember what it was like for the intern reading your report to understand all the esoteric mumbo jumbo we put in the reports and how clinically relevant or irrelevant things were.

If you can take from intern year a better understanding the knowledge base of referring clinicians from various specialties and various training levels, the clinical workflow, and the clinical decision making, you will be a better radiologist because you will communicate in a clearer and more relevant manner.

Also, remember all your interactions with radiology, so you will treat others as you wish you were to be treated.

Some things I remember from intern year
-my rheumatology attending not knowing what a "TFCC" was
-getting important findings alerts in my inbox and not understanding what was so important about them and just ignoring them
-getting a readout of a CTA runoff impression over the phone and not understanding what any of it meant
-asking the radiology resident what she meant by 'nonspecific findings that may be seen with normal pressure hydrocephalus' and what I do with that information
-being talked down to and out of a lung biopsy because the patient had severe COPD
-reading a CT abdomen impression that actually sounded like it was trying to address the question I asked

Also, picking up the colloquialisms and knowledge about cutting edge medicine in general is useful. Don't be anxious you can't see a direct connection to radiology yet. For instance, I had to explain to radiology attendings about CAR-T cells and what 'HFpEF' stood for. These small things make you look good.

 

[loljkttyl]

Don't read Brandt and Helms or Felson's as an intern. Not even sure it's worth your time as a resident. During your intern year, familiarize yourself with basic anatomy using online radiology atlases such as e-Anatomy (identify major organs on body CT +/- lymph node stations if ambitious) +/- headneckbrainspine.com (for neuroanatomy). If you want a head start on radiology, the most high-yield text is Core Radiology: A Visual Approach to Diagnostic Imaging. It is bullet-pointed, filled with pictures, and easy and fun to read. At your level, skim thoracic, gastrointestinal, genitourinary, and musculoskeletal sections as well as ultrasound; skip all other sections.

 

[Gadofosveset]

Ditto looking at the radiology reports carefully. Soon you will be on the other end of the powermic and will struggle to remember what it was like for the intern reading your report to understand all the esoteric mumbo jumbo we put in the reports and how clinically relevant or irrelevant things were.

If you can take from intern year a better understanding the knowledge base of referring clinicians from various specialties and various training levels, the clinical workflow, and the clinical decision making, you will be a better radiologist because you will communicate in a clearer and more relevant manner.

Also, remember all your interactions with radiology, so you will treat others as you wish you were to be treated.

Some things I remember from intern year
-my rheumatology attending not knowing what a "TFCC" was
-getting important findings alerts in my inbox and not understanding what was so important about them and just ignoring them
-getting a readout of a CTA runoff impression over the phone and not understanding what any of it meant
-asking the radiology resident what she meant by 'nonspecific findings that may be seen with normal pressure hydrocephalus' and what I do with that information
-being talked down to and out of a lung biopsy because the patient had severe COPD
-reading a CT abdomen impression that actually sounded like it was trying to address the question I asked

Also, picking up the colloquialisms and knowledge about cutting edge medicine in general is useful. Don't be anxious you can't see a direct connection to radiology yet. For instance, I had to explain to radiology attendings about CAR-T cells and what 'HFpEF' stood for. These small things make you look good.

In my opinion the most useful thing you can do is...

To make a "radiology diary" as an intern.
Hear me out.

It's like Cognovi was suggesting in paying attention to the reports. As you go through the year write down any time there was something in a report that confused you, seemed like it was worded poorly, didn't answer your question. Make a note of pushback from the imaging dept, how did the people on the phone make you feel? What should you have brought to the conversation? What did they not seem to understand? Make a note of the general culture of the radiology dept and the reading room at your department. Is it friendly? Off putting? What would make it better?

You will only have these honest "naive" impressions once, but they are still valid. Pretty soon they will all disappear as you go to the other side of the phone and you get more experience. You will completely forget what it was like unless you have the diary. The reason this is important is because as an attending you will be working with intern-level folks your entire career. Either literally (in an academic center) or practically (poorly prepared NPs or physicians in the hospital). You will need a refresher on what was not working so you don't perpetuate the same mistakes moving forward. I wish I had done this.

 

[Smoking Jay Cutler]

Look at the imaging performed on your patients, try to make some findings, and then read the reports and try to find the things you didn't see.
You're not expected to have read radiology textbooks before starting radiology residency.

When you start R1, work hard right away and make good initial impressions on the people you work with.

 

[sievert_fever]

If you're going to review anything, I agree with e-Anatomy. I also think Core Radiology (Mandell) is a nice intro textbook; just gloss through it for concepts and ignore the minutiae.

 

[CherryRedDracul]

William Herring's Learning Radiology was all I read before R1 year. Matter of fact, I read it during MS4 (because we had an exam at the end of our rads rotation).

IMO, it did come in handy during intern year for the simple stuff so I didn't have to bother the on-call residents for simple questions.

Otherwise, yeah, don't sweat it. You're expect to know nothing when you start.